Healthy People 2020, which establishes the health agenda for the United States, promotes a societal vision whereby all individuals lead long healthy lives free of preventable disease, disability, injury, and premature death. Yet new evidence in this issue of JAMA finds that vision well beyond the reach of far too many people.1

Since 1990, the Global Burden of Disease (GBD) study has pioneered a series of investigations that rank countries through a comprehensive set of health and disease measures. GBD 2016, which includes a focus on US and state health outcomes (1990-2016), highlights an array of substantial, mostly preventable, physical, mental, and social burdens. Despite notable improvements in some outcomes, the US disease burden is shared unequally. Prior research has established that the United States, like many other nations, is aging and increasingly diverse in terms of race and ethnicity, socioeconomic status, sexual orientation, and gender identity. Now GBD 2016 also documents key health disparities by geography that leave the United States far from being united. These findings have broad implications for clinicians and policy makers, as well as specific implications related to certain risk factors and conditions.